Fig. 1: Flow diagram of families referred for rWGS and the rate of consent to the study.

Eighty-six percent of families who underwent the informed consent process enrolled in the rWGS study. *Three families did not undergo informed consent process (one maxed out on number of contact attempts per research protocol, two for unknown reasons). The majority of families underwent trio rWGS (67%). **Four families declined participation after informed consent process: two secondary to concerns for lack of protection under GINA (Genetic Information Nondiscrimination Act of 2008, Pub. L. 110–233, 122 Stat. 881), one wanted more than just phenotype driven genetic information, and one did not follow up after consent process.